View the NBME Annual Report - National Board of Medical Examiners

2012 Annual Report
United States Medical Licensing Examination® (USMLE®)
As a result of its review, the Step 2 Committee decided to increase the performance levels required to receive a passing outcome
on two of the three Step 2 CS subcomponents, Communication and Interpersonal Skills and Integrated Clinical Encounter,
effective with administrations beginning January 1, 2013.
COMPREHENSIVE REVIEW OF USMLE
The Comprehensive Review of USMLE (CRU) is a multiyear project to review and revise the USMLE sequence. Key activities
during 2012 included:
New Assessment Formats for USMLE: Skills in the Interpretation of the Medical Literature
One of the recommendations emerging from the CRU process is that USMLE develop assessments focusing on the examinee's
ability to access relevant information, evaluate its quality, and apply it to solving clinical problems. Among the formats
under development to help meet this recommendation are multiple-choice questions that assess an examinee's ability to
appropriately interpret information presented both in the form of a research abstract and of a pharmaceutical advertisement.
NBME staff members have been working with Drug Ad and Abstract/Search Task Forces to develop new assessment
formats based on these tasks. Items with an associated pharmaceutical advertisement or abstract were introduced into the
USMLE Step 3 examination beginning in February 2012.
An additional area of focus is development of new item formats that effectively assess an examinee's ability to search and
appropriately employ information resources to solve clinical problems. The literature interpretation items mentioned above
begin that process, and over the next several years we hope to enhance the USMLE's assessment of an examinee's ability to
formulate a research question from a clinical dilemma, develop and execute a search of information resources, weigh the results
of that search, and use the results to solve a clinical problem.
Enhancements to Existing USMLE Item Formats: Assessment of Science in a Clinical Context
Efforts to assess basic science knowledge in a clinical context in the Step 1 examination have been underway for several
years. One of the recommendations emerging from the CRU process is that USMLE emphasize the importance of the scientific
foundations of medicine in all components of the assessment process and that the assessment of these foundations occurs
within a clinical context or framework, to the greatest extent possible. In continued support of this recommendation,
item development activities in 2012 included increased emphasis on items assessing foundational science in Step 3.
Enhancements to Existing USMLE Item Formats: Step 2 Clinical Skills
Enhancements to the Step 2 CS examination will extend both the nature and degree of challenges faced by examinees. Several
changes to the Step 2 CS examination were introduced beginning in mid-June 2012. The Communications and Interpersonal
Skills subcomponent of Step 2 CS has been redesigned to assess a fuller range of competencies. Research into the
assessment of more advanced communications skills will continue in 2013 and 2014. In addition, a redesigned patient note
was introduced. Examinees will continue to document relevant history and physical examination findings and to list initial
diagnostic studies to be ordered. They will also be asked to create a reasoned, focused differential diagnosis listed in order
of likelihood, and to indicate the evidence obtained from the history and physical examination that supports each potential
diagnosis. The new patient note provides examinees with an opportunity to document their analysis of a patient's possible
diagnoses.
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